Oriot D, Berthier M, Saulnier J P, Blay D, Fohr J P, Vuillerme V, Saulnier J B
Paediatric Department, University Hospital, Poitiers, France.
Acta Paediatr. 1998 Sep;87(9):1005-7. doi: 10.1080/080352598750031707.
Recommendations to adopt the supine position were followed by a dramatic decrease of SIDS. But no explanation has been given for the association between SIDS and the prone position nor for its decrease in the supine position. We report data on an infant and a mannequin demonstrating an increase in temperature around the head in the prone position. A 4-month-old boy presented an acute life-threatening event related to temperature after febrile otitis despite treatment: 40.5 degrees C, heart rate 280 bpm with circulatory failure and cardiorespiratory arrest requiring resuscitation. There were no seizures. Blood and CSF cultures were negative. The course under antibiotics was favourable. On d 3, we measured temperature at several sites on and around the heat. Temperatures were higher in the prone than in the supine position in pericephalic areas: +1 degrees C (supracephalic), +2.5 degrees C (peritemporal), and +3.5 degrees C (submandibular). In a thermoregulated room, we used a mechanically ventilated mannequin of an infant. The prone position was also associated with an increase in temperature around the head: +3.3 degrees C (supracephalic), +1.8 degrees C (peritemporal), and +1.1 degrees C (submandibular). Changing from the supine to prone position thus increased temperature around the head (infant and mannequin). To our knowledge, this has not been reported before. SIDS is related to factors modifying temperature status and environment. Furthermore, evacuation of heat is mandatory for an infant. We think the increase in temperature around the head in the prone position is due to the absence of convective fluxes, and speculate it could impair thermolysis.
采取仰卧位的建议实施后，婴儿猝死综合征（SIDS）的发生率显著下降。但目前尚无关于SIDS与俯卧位之间关联的解释，也没有关于仰卧位时SIDS发生率下降原因的解释。我们报告了一项针对一名婴儿和一个人体模型的数据，该数据表明俯卧位时头部周围温度会升高。一名4个月大的男婴在患发热性中耳炎接受治疗后，出现了与体温相关的急性危及生命事件：体温40.5摄氏度，心率280次/分钟，伴有循环衰竭和心肺骤停，需要进行复苏。未发生惊厥。血液和脑脊液培养均为阴性。抗生素治疗过程顺利。在第3天，我们测量了头部及周围几个部位的温度。在头颅周围区域，俯卧位时的温度高于仰卧位：头顶部升高1摄氏度，颞部周围升高2.5摄氏度，下颌下升高3.5摄氏度。在一个温度可控的房间里，我们使用了一个机械通气的婴儿人体模型。俯卧位同样与头部周围温度升高有关：头顶部升高3.3摄氏度，颞部周围升高1.8摄氏度，下颌下升高1.1摄氏度。从仰卧位变为俯卧位会使头部周围温度升高（婴儿和人体模型均如此）。据我们所知，此前尚未有过此类报道。SIDS与改变体温状态和环境的因素有关。此外，婴儿必须能够散热。我们认为俯卧位时头部周围温度升高是由于缺乏对流，并且推测这可能会损害热解过程。
